Anticholinergic Drugs and Their Effects on Delirium and Mortality in the Elderly

Aim: To investigate the use of drugs with anticholinergic properties (DAPs) and their associations with delirium and mortality among elderly patients with comorbidities. Methods: 425 patients (≧70 years of age) in geriatric wards and nursing homes were assessed. The use of DAPs was retrieved from their medical records. Delirium was diagnosed according to the DSM-IV criteria. Results: Of the 341 patients (80.2%) treated with multiple DAPs (≧2), 92 patients (27.0%) suffered from delirium, whereas 14 of 84 patients (16.7%) without DAP treatment had delirium (p = 0.050). In a logistic regression analysis with age, gender, and Charlson Comorbidity Index as covariates, DAP treatment did not predict delirium (odds ratio 1.67, 95% confidence interval 0.87–3.21). The 2-year mortality was 49.3% (n = 168) in DAP users and 35.7% (n = 30) in non-users, respectively (p = 0.026). In the Cox proportional hazard model adjusted for age, gender, and comorbidity, DAPs did not predict mortality (hazard ratio 1.12, 95% confidence interval 0.75–1.68). Conclusion: The use of DAPs is very frequent among frail inpatients with comorbidities, but their use has no independent prognostic significance.

[1]  Janet B W Williams.  Diagnostic and Statistical Manual of Mental Disorders , 2013 .

[2]  F. Pasquier,et al.  Drugs with anticholinergic properties, cognitive decline, and dementia in an elderly general population: the 3-city study. , 2009, Archives of internal medicine.

[3]  Donna Fick,et al.  The cognitive impact of anticholinergics: A clinical review , 2009, Clinical interventions in aging.

[4]  Sharon K. Inouye,et al.  Delirium in elderly adults: diagnosis, prevention and treatment , 2009, Nature Reviews Neurology.

[5]  T. Strandberg,et al.  Association Between Anticholinergic Drugs and Apolipoprotein E ɛ4 Allele and Poorer Cognitive Function in Older Cardiovascular Patients: A Cross‐Sectional Study , 2009, Journal of the American Geriatrics Society.

[6]  R. Tilvis,et al.  Predisposing and precipitating factors for delirium in a frail geriatric population. , 2008, Journal of psychosomatic research.

[7]  M. Boustani,et al.  Impact of anticholinergics on the aging brain: a review and practical application , 2008 .

[8]  R. McGlinchey,et al.  The anticholinergic risk scale and anticholinergic adverse effects in older persons. , 2008, Archives of internal medicine.

[9]  S. Inouye.  Delirium in older persons. , 2006, The New England journal of medicine.

[10]  J. Touchon,et al.  Non-degenerative mild cognitive impairment in elderly people and use of anticholinergic drugs: longitudinal cohort study , 2006, BMJ : British Medical Journal.

[11]  T. Strandberg,et al.  Multicomponent geriatric intervention for elderly inpatients with delirium: a randomized, controlled trial. , 2006, The journals of gerontology. Series A, Biological sciences and medical sciences.

[12]  T. Strandberg,et al.  Delirium among patients with and without dementia: does the diagnosis according to the DSM‐IV differ from the previous classifications? , 2004, International journal of geriatric psychiatry.

[13]  M. Beers,et al.  Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. , 2003, Archives of internal medicine.

[14]  T. Strandberg,et al.  The Impact of Different Diagnostic Criteria on Prevalence Rates for Delirium , 2003, Dementia and Geriatric Cognitive Disorders.

[15]  J. Mintzer,et al.  Anticholinergic side-effects of drugs in elderly people , 2000, Journal of the Royal Society of Medicine.

[16]  Trzepacz Pt.  Is there a final common neural pathway in delirium? Focus on acetylcholine and dopamine. , 2000 .

[17]  S. Inouye.  Predisposing and Precipitating Factors for Delirium in Hospitalized Older Patients , 1999, Dementia and Geriatric Cognitive Disorders.

[18]  L. Lipsitz,et al.  Neural mechanisms of delirium: current hypotheses and evolving concepts. , 1999, The journals of gerontology. Series A, Biological sciences and medical sciences.

[19]  T R Holford,et al.  A multicomponent intervention to prevent delirium in hospitalized older patients. , 1999, The New England journal of medicine.

[20]  J. Rabe-Jabłońska,et al.  [Affective disorders in the fourth edition of the classification of mental disorders prepared by the American Psychiatric Association -- diagnostic and statistical manual of mental disorders]. , 1993, Psychiatria polska.

[21]  L. Tune,et al.  Anticholinergic effects of drugs commonly prescribed for the elderly: potential means for assessing risk of delirium. , 1992, The American journal of psychiatry.

[22]  C. P. Hughes,et al.  A New Clinical Scale for the Staging of Dementia , 1982, British Journal of Psychiatry.

[23]  Z. J. Lipowski.  A new look at organic brain syndromes. , 1980, The American journal of psychiatry.

[24]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[25]  J. Pickova.  The Measurement and Appraisal of Adult Intelligence , 1959 .

[26]  D. Wechsler.  The Measurement Of Adult Intelligence , 1952 .

[27]  L. Goodman,et al.  THE PHARMACOLOGICAL BASIS OF THERAPEUTICS , 1966 .

[28]  G. Lawton.  THE MEASUREMENT OF ADULT INTELLIGENCE , 1939 .

[29]  T. Vahlberg,et al.  Effects of Potent Anticholinergics, Sedatives and Antipsychotics on Postoperative Mortality in Elderly Patients with Hip Fracture , 2009, Drugs & aging.

[30]  S. Ferris,et al.  Scopolamine effects on memory, language, visuospatial praxis and psychomotor speed , 2005, Psychopharmacology.

[31]  D. Chutka,et al.  Inappropriate medications for elderly patients. , 2004, Mayo Clinic proceedings.

[32]  R. Hu.  Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) , 2003 .

[33]  P. Trzepacz.  Is there a final common neural pathway in delirium? Focus on acetylcholine and dopamine. , 2000, Seminars in clinical neuropsychiatry.

[34]  K. E. Newhouse.  Goodman and Gilman's The Pharmacological Basis of Therapeutics , 1986, The Yale Journal of Biology and Medicine.

[35]  C. Mackenzie,et al.  A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. , 1987, Journal of chronic diseases.

[36]  D. Wechsler.  The measurement and appraisal of adult intelligence, 4th ed. , 1958 .